Monday, November 24, 2014

Chapter 30 - Saint Elizabeths: Part 5 - The Pathology Lab

All rights reserved. Copyright material may be quoted verbatim without need for permission from or payment to the copyright holder, provided that attribution is clearly given and that the material quoted is reasonably brief in extent.With White’s guidance, St. Elizabeths indeed seemed like the perfect place for Korzybski to learn more about some of the unfortunate extremes of human ‘mental’ life. White’s broad knowledge of biological mechanisms, his background in medicine and neurology, and his wide experience with psychotherapy and with psychiatric patients, would not allow White to overemphasize any single cause or treatment for ‘mental’ disorders or to leave his compassion behind. Even as the editor of The Psychoanalytical Review, White was not bound to Freudian psychoanalysis but was quite open to other schools of psychotherapy, which were then developing. Furthermore, knowing intimately the infectious, toxic, traumatic, and other medical causes for some ‘mental’ disorders, he was not one to think of psychotherapy as the treatment of choice for every psychiatric illness. Indeed, psychotherapy often didn’t seem much of a treatment even for those patients for whom it was deemed appropriate. Of all people White, the superintendent of perhaps the largest and best-run asylum in the world, knew the limitations of psychiatry in the mid-1920s. A lot was known but there was still a lot more to be known (still the case in 2011 [2014]).

As a result of all this, White had adopted the organism-as-a-whole-in-an-environment viewpoint long before he met Korzybski and undoubtedly reinforced Alfred’s caution about his own work. Even though confusion of orders of abstractions seemed to be a general feature observable in the broad range of psychiatric disorders (as well as in everyday misevaluations), both White and Korzybski realized that training to become conscious of abstracting was not necessarily going to reverse the confusion in everyone. Nonetheless, the preventive and therapeutic possibilities of Alfred’s work for ‘mental’ health were still unknown.

White and Korzybski clearly shared a matter of principle (a basic postulate): any manifestation of ‘mind’—sanity, insanity, or unsanity—must correlate with some neurological event(s). This meant that psychotherapy, or any form of education for that matter, must also as a matter of principle involve some kind of nervous system-brain event(s)—whether or not they could be detected or understood with 1920s-era methods and theories.

Korzybski’s curiosity about the neurology of insanity and sanity had definitely been stimulated at the hospital. For example, he wondered about the people whom he had encountered with the diagnosis of dementia praecox (a term still being used, and which Korzybski favored, for what Bleuler had relabeled “schizophrenia” almost 20 years before). Alfred realized that any diagnostic label used could misleadingly objectify what might constitute nothing more than a “bundle of very loose[ly] connected symptoms.”(29) Still, the symptoms in a patient with a typical form of dementia praecox seemed connected enough, however hard to explain them. What was going on in their brains? (Of course, not much was known about what happened in ‘normal’ people’s brains either.) The illness often suddenly manifested itself in young people in their late teens or early twenties who, in the worst cases, could show a seemingly unstoppable course of deterioration. Alfred had seen one such young man in the receiving ward after the medical exam was done. The man had been a soldier. One day he simply walked out of parade formation, returned to the barracks, and went to sleep. He was court-martialed, then sent to jail, then to a military hospital, and then to St. Elizabeths. Alfred talked with him for about two hours. Their conversation seemed normal on one level, but in another way there seemed something odd about the man. As Alfred recalled, the man was “polite with a sort of grin, couldn’t be any better. In the meantime he was completely dead. It is beyond description…You feel it.”

And it is a very curious thing, that deadness, what they call it, lack of affective tone, complete deadness. No feeling at all. Polite, responsive, yes, no, this way, everything coherent, no feeling. And [on] this ground alone he was confined. No doctor will miss this kind of thing. I couldn’t miss it, a layman, so he was confined. I believe I saw him later, three, four months later, and he was completely gone. No more even coherent. (30)

If Alfred wanted to learn as much as he could about the brains of schizophrenics and other people with ‘mental’ disorders, St. Elizabeths seemed like the perfect place to do that too. Since the hospital had a large patient population, when one died—not an infrequent occurrence—an autopsy was done whenever possible at the hospital’s state-of-the-art Blackburn Pathology Laboratory. Alfred attended every autopsy he could. He estimated that he observed about 300 during his two years at the hospital. The autopsy would be done in the lab’s operating theatre, which had a balcony where medical students from George Washington and Georgetown Universities could sit and watch the presiding pathologist, either Nolan D.C. Lewis or Walter J. Freeman II, do his work while lecturing about his findings. Alfred liked to watch up close, standing near the doctor on the ground floor.

Nolan D.C. Lewis, also the director of clinical psychiatry at the hospital, had begun his medical career as a neurologist and neuropathologist but had developed his early interests in human behavior by taking additional training in psychology and psychiatry. While becoming quite involved with psychotherapy and psychoanalysis, he maintained his interests in neurology and neuropathology, and did a large number of the autopsies Korzybski observed at the laboratory. Lewis later directed the lab from 1933 until leaving St. Elizabeths in 1936, when he took a teaching post at Columbia University Medical School. He later became the Director of the New York State Psychiatric Institute and Hospital.(31) He and Korzybski maintained contact over the years, with Lewis becoming an Honorary Trustee of the Institute of General Semantics. Following his friend’s final wishes, Lewis took care of the autopsy on Alfred’s remains in 1950.

Walter Freeman II—trained as a neurologist specializing in neuropathology—had been recently hired by White as the lab’s senior medical officer. Young Freeman was known among the medical students as a dynamic teacher. He also expanded and developed the lab facilities, including the hospital’s ‘brain library’ where Alfred spent time studying. As Alfred recalled: “…we conserved the brains—we cut the brain apart microscopically and I don’t know what not. We had a beautiful library, so to say, of brains, in jars, with histories and what not—and slices—oh, I don’t know—thousands, thousands.”(32) Unlike Lewis, Freeman had minimal training in psychiatry or psychotherapy, and apparently little enthusiasm for those disciplines, despite working for William Alanson White. Psychotherapy played no part in the part-time private practice in neurology Freeman established several years later, although he saw a large number of people with psychiatric complaints (at the time not out of the ordinary for neurologists). In his early practice he prescribed drugs (at that time not effective therapeutically for much more than sedation) “or suggested an exercise regime or a change in life style.”(33) In 1933, he left St. Elizabeths, having already become one of the earliest advocates of various shock therapies (electrically and drug induced) for mental disorders. Sometime afterwards, he would become the chief American exponent of psychosurgery, specifically frontal lobotomy (destroying nerve tracts by swishing around an ice-pick-like instrument driven into the skull through a tear duct), which he recommended for a wide variety of psychiatric diagnoses.

To White’s great credit, when Freeman and his partner were just getting started with the procedure in the late 1930s and wanted White to let them do it at St. Elizabeths, White told Freeman, “It will be a hell of a long while before I’ll let you operate on any of my patients.”(34) By 1949, although the procedure had become widely accepted and practiced, Lewis—who believed it was being done indiscriminately—had become one of its most vocal critics, as well.(35)

At the pathology lab, Korzybski learned from and had friendly relations with both Lewis and Freeman, who appeared to have something of an unfriendly rivalry. Ultimately, Korzybski’s interests and viewpoint were at odds with those of Freeman. Even for his time and despite his apparent brilliance, Freeman demonstrated a simplistic understanding of the complexities of the brain and human behavior. Although I haven’t found any documentation of Korzybski’s view on lobotomy, it seems unlikely it would have differed much from that of White and Lewis. Though accepting the principle that brain and consciousness/behavior must correlate, Alfred’s brain studies had already led him to conclude: “[T]here is very little correspondence in the behavior and the [macroscopic] structure of the brain [on autopsy].” (Freeman’s later forays into people’s brains focused on this macroscopic level although no one had demonstrated visible defects in the brains of the people, such as schizophrenics, upon whom he was doing the surgery.) For Korzybski, extending a physico-mathematical, process orientation into neurology and psychiatry meant that the main ‘action’ in the nervous system did not exist at the level of fiber tracts or other gross (visible) brain anatomy. More subtle, invisible, submicroscopic, organism-as-a-whole-in-environment processes had to be involved to explain mentality and behavior. How else to explain the following observation which he recounted years later?

I remember that fellow who was quite normal in grand parole, means the garden, quite normal but low grade. And when he died and we made an autopsy, he had no brain at all. The cavity was full. It was a bag of pus. No conformation of a brain at all. And yet on the surface he somehow behaved. This was the most interesting brain I saw. (36)

Of course, something appeared visibly wrong with that man’s brain, such as it was. But the coherency of his behavior while alive (walking around, smiling, saying “hello”, etc.) didn’t seem to match the incoherency of the ‘mush’ they later saw inside his skull. Something coherent must have been happening inside his skull while he was alive, in spite of the presumed loss of distinctiveness in his brain matter.

Before the explosion of molecular biology in the 1950s, colloidal science was an active area of research for trying to understand this submicroscopic realm in the life sciences. Over the next few years Alfred began to look to electro-colloidal processes in order to explain what he had seen. For it had become clear to him that neurological events—related to ‘thinking’,‘feeling’, and other aspects of human activity—could not be understood very well just by looking at macroscopically (or even microscopically) visible brain structures. He knew that more subtle brain mechanisms had to exist, awaiting exploration. Alfred had begun to understand disturbed ‘thinking’ as significantly related to such subtle neural events (whatever they consisted of and whether or not they could be detected by the science of the day). Whatever methods could be devised to make ‘thinking’ less disturbed, necessarily had to change neural processes for the better as well. Indeed, he considered ‘thinking’ and related neural events as different dimensions of a single, ongoing process.

He had spiraled back to the spiral theory presented in Manhood of Humanity. Viewing ‘thinking’, ‘feeling’, ‘consciousness’—in other words, abstracting—in neurological terms would become more and more important to the viewpoint Alfred was developing for his book. At the end of 1926, his second year at St. Elizabeths, Alfred—who had begun reading a lot of neurology—read C. Judson Herrick’s The Brains of Rats and Men and noted the following statement, which he later quoted in his book:

To some extent, the practice of thinking, deciding, feeling, appreciating, and sympathizing molds the personality of the thinker. Presumably, the stable patterns of cortical association are changed by the performance of these acts just as on a lower plane muscles are changed by systematic exercise. (37)

Alfred’s physico-mathematical analysis of human behavior in terms of ‘logic’, premises, space-time orientation, neurological mechanisms, etc., may have seemed cold and overly intellectual to some. For Alfred, it was not. Indeed, at St. Elizabeths he began to undergo some deep ‘emotional’ changes of his own. The changes had resulted from observing and talking with patients and using the imaginative skills he had developed from his physico-mathematical training. Eventually he realized: his imaginative reconstruction of people’s life situations (in terms of—and visualizing, etc.—the underlying assumptions they lived by, what and how they abstracted, etc.) helped him to reduce his own psychological ‘sore spots’and thus deal with all sorts of humans and human reactions, with a minimum of upset. He described the process in detail to a seminar group at the end of 1948:

...I had enough imagination—mathematical training—imagination, to fancy myself in such and such a situation or with such and such impulses. My work has been done only because I was able to be my own guinea pig and my own laboratory. This is a very important thing. Now for instance with students—the number goes by the thousands, you know—in the past I knew intimately the life of every student. I imagined myself, I imagined how—imagination, engineering, mathematics, physics—how would I react under such and such conditions, how would I react under such and such impulses. I deliberately lived through all of that and it left me personally immune.* (38)

*Korzybski insisted on the necessity of ‘introspection’ for a scientific psychiatry and “psycho-logics” (see Science and Sanity, 5th Edition, pp. xlii-xliii and 359-360).]

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About Bruce I. Kodish

I've received wide acknowledgment as a leading scholar-teacher of the korzybskian discipline of applied epistemology known as 'general semantics'. In 1998, with my wife Susan Presby Kodish, Ph.D., I received the Institute of General Semantics' prestigious J. Talbott Winchell Award. With"deep appreciation and warm thanks" the award acknowledged the Kodish's "...many contributions severally and together to the wider understanding of general semantics as authors, editors, teachers, leaders", and "their concern with the alleviation of social and individual problems, and their active interest in the on-going work in general semantics." I've written the first full-length biography of Alfred Korzybski, author of Manhood of Humanity and Science and Sanity: An Introduction to Non-Aristotelian Systems and General Semantics. My book, Korzybski: A Biography, received the S.I. Hayakawa Book Prize in 2011. Although I am retiring this year after 36 years as a physical therapist, I continue a lively interest in corrective exercise and rehabilitation and have a part-time practice as a consultant and personal trainer specializing in the Alexander Technique of Posture-Movement Education.